11/123. pregnancy in hyperprolactinemic infertile women treated with vaginal bromocriptine: report of two cases and review of the literature.Vaginal bromocriptine has proven safe and effective in treating hyperprolactinemic women. However, there has been no long-term clinical assessment regarding the influence of daily vaginal bromocriptine administration on the ability to conceive. This article presents two cases of successful pregnancy resulting from this alternative treatment. An infertile woman with an empty sella and hyperprolactinemia was treated with vaginal bromocriptine because of intolerance to oral administration. Prolactin levels were quickly normalized and no side effects occurred. Repeated postcoital tests during treatment proved normal. Twelve months later, the patient conceived. The therapy was discontinued during pregnancy, without complications. Although bromocriptine treatment was not resumed after delivery, postpartum prolactin levels were lower than before treatment and magnetic resonance imaging revealed an unchanged empty sella. Another patient with infertility and pituitary microadenoma with intolerance to oral dopaminergic agonists received the same treatment. Prolactin quickly fell to within the normal range. Vaginal bromocriptine was well tolerated and postcoital test results were not impaired. Tumor regression occurred and 10 months later the patient conceived. Despite bromocriptine withdrawal, no significant complications occurred during pregnancy. It can therefore be concluded that a couple's fertility does not appear to be significantly affected by the persistent local presence of bromocriptine.- - - - - - - - - - ranking = 1keywords = pituitary (Clic here for more details about this article) |
12/123. Isolated adrenocorticotropic hormone deficiency, thyroid autoimmunity, and transient hyperprolactinemia.OBJECTIVE: To describe a case of isolated adrenocorticotropic hormone (ACTH) deficiency associated with thyroid autoimmunity, subclinical hypothyroidism, and transient hyperprolactinemia. methods: We present a detailed case report, including results of laboratory studies and magnetic resonance imaging, and discuss potential contributing factors in this setting. RESULTS: In a 23-year-old woman with isolated ACTH deficiency accompanied by thyroid autoimmunity (Hashimoto's thyroiditis), subclinical primary hypothyroidism, and hyperprolactinemia, magnetic resonance imaging of the pituitary showed normal findings but dynamic stimulation testing of the pituitary gland indicated an isolated ACTH deficiency with intact growth hormone and gonadotropin secretory reserves. The cortisol response to the short ACTH stimulation test was subnormal. Therapy with prednisolone (5 mg/day) and levothyroxine (100 microg/day) was initiated. Results of thyroid function tests were normalized after 1 month, the prolactin level decreased to normal after 1 year, and titers of thyroid autoantibodies decreased substantially after 1.5 years of treatment. CONCLUSION: The correction of the related glucocorticoid deficiency resulted in resolution of the hyperprolactinemia and a decrease in titers of thyroid autoantibodies.- - - - - - - - - - ranking = 2.8771827186165keywords = pituitary, pituitary gland, gland (Clic here for more details about this article) |
13/123. Multiple intracranial recurrent tumors with hyperprolactinemia combined with a parasellar malignant fibrous histiocytoma long after transfrontal surgery and irradiation to a pituitary adenoma.We herein describe a 40-year-old woman with hyperprolactinemia, an empty sella and two extrasellar intracranial recurrent tumors which were revealed 23 years after the first transfrontal craniotomy and 18 years after the second transfrontal surgery and irradiation to a provable prolactin-producing pituitary macroadenoma. One recurrent tumor was in the right orbital apex causing right oculomotor nerve palsy, and the other tumor was in the right apex partispetrosae and foramen jugulare. Although her serum prolactin level decreased after the administration of bromocriptine mesilate, and the size of the two tumors remained unchanged, a malignant fibrous histiocytoma, which might have been induced by the irradiation 18 years before, grew rapidly in the right suprasellar-prepontine cistern to the right pedunculus cerebralis, leading to a poor prognosis. This case confirmed the importance of the life-lasting follow-up of pituitary adenomas treated with surgery and/or irradiation therapy. Not only ectopic recurrence of the primary tumor but also post-irradiation tumors may become apparent long after the removal of the primary tumor.- - - - - - - - - - ranking = 6keywords = pituitary (Clic here for more details about this article) |
14/123. Chromosomal aberrations in pituitary carcinoma metastases.Four pituitary carcinoma metastases [two adrenocorticotropic hormone (ACTH) and prolactin cell tumors each] were studied by comparative genomic hybridization. Chromosomal gains were found in all four carcinoma metastases, but losses only in the two prolactin cell carcinoma metastases. overall, pituitary carcinoma metastases showed an average of 8.3 chromosomal imbalances per tumor (7 gains vs 1.3 losses), 10 in prolactin cell carcinoma metastases (7.5 gains vs 2.5 losses) and 6.5 in ACTH cell carcinoma metastases (6.5 gains vs 0 loss). The most common changes were gains of chromosome 5, 7p, and 14q (in three tumors each). High-level gains were found on 13q22-qter and 14q (two cases each) and on 1q, 3p, 7, 8, 9p, and 21q (one case each). To date, gains of chromosome 14q have not been reported among pituitary tumors. It remains to be shown whether gain of 14q is associated with malignant progression and metastatic dissemination of pituitary carcinomas.- - - - - - - - - - ranking = 8keywords = pituitary (Clic here for more details about this article) |
15/123. Unusual case presentation of lichen simplex chronicus, Hodgkin's lymphoma, and nonpuerperal hyperprolactinemia-galactorrhea.OBJECTIVE: To report the association of nonpuerperal galactorrhea and severe pruritus with clinical stage IIB Hodgkin's lymphoma. methods: We present a detailed history, findings on physical examination, laboratory data, and results of diagnostic imaging in a 25-year-old woman. A review of the related literature and speculations about possible etiologic factors for this association are provided. RESULTS: Dermatologic evaluation of the patient revealed lichen simplex chronicus with multiple excoriations on the anterior chest area and lower extremities. High serum prolactin concentrations and easily expressible galactorrhea were present. magnetic resonance imaging of the sella with 1-mm cuts, however, revealed a normal pituitary gland. Computed tomography showed multiple enlarged mediastinal lymph nodes, and a left supraclavicular lymph node biopsy revealed the presence of reed-sternberg cells and lymphocyte alterations consistent with the diagnosis of Hodgkin's lymphoma. After one cycle of chemotherapy for management of the lymphoma, parallel reductions in serum prolactin concentrations and galactorrhea were noted. CONCLUSION: Possible causes for this syndrome include afferent mammary nerve stimulation resulting from scratching of pruritic skin and cytokine-induced hypersecretion of prolactin attributable to the lymphoma. Although uncommon, this syndrome may serve as an important harbinger of developing Hodgkin's lymphoma, and its disappearance may signify a therapeutic response.- - - - - - - - - - ranking = 1.8771827186165keywords = pituitary, pituitary gland, gland (Clic here for more details about this article) |
16/123. Anovulatory infertility: a report of four cases and literature review.Four cases of anovulatory/dysovulatory infertility encountered in Ilorin, nigeria are presented and the literature extensively reviewed on the up-to-date management of this aspect of infertility. All the patients had bilateral tubal patency on hysterosalpingography (HSG) and their husbands had normal seminal fluid analysis. The first case, 30 years of age, had hyperprolactinaemia with galactorrhoea, treated with bromocriptine given 2.5 mg twice daily. Another case, aged 27 years, had polycystic ovarian syndrome with hyperprolactinaemia but no galactorrhea This was treated with clomiphene citrate 100 mg daily. The third case, 34 years old, had hypothyroidism with hyperprolactinaemia and galactorrhea and was treated with thyroxine. The last case, aged 32 years, had hyperprolactinaemia and was treated with bromocriptine and clomiphene citrate. None of the patients had demonstrable pituitary adenoma. After the appropriate treatment, ovulatory menses were restored in all the patients; two have been pregnant, while the other two have not yet achieved pregnancy but have having regular ovulatory menses. All the patients are Nigerians.- - - - - - - - - - ranking = 1keywords = pituitary (Clic here for more details about this article) |
17/123. Concomitant occurrence of macroprolactin, exercise-induced amenorrhea, and a pituitary lesion: a diagnostic pitfall. Case report.The authors report the case of a 37-year-old woman who presented with amenorrhea and an increased level of serum prolactin. Magnetic resonance images of the pituitary revealed a lesion with characteristics consistent with those of a microadenoma. Transsphenoidal exploration was performed, but a prolactinoma was not found. After endocrinological review, the patient's hyperprolactinemia was found to be caused by the presence of macroprolactin and her amenorrhea was due to intense exercise and low body weight. Macroprolactin is an isoform of prolactin that is variably reactive in assays for prolactin, but displays minimum bioactivity in vivo. patients with macroprolactin are mostly asymptomatic. This phenomenon may cause elevated prolactin values, which the authors view as apparent hyperprolactinemia. The presence of macroprolactin is an underrecognized problem, occurring in as many as 15 to 20% of patients with elevated prolactin values and often leading to unnecessary, expensive diagnostic procedures and inappropriate treatment. The presence of macroprolactin should always be suspected when the patient's clinical history or clinical or radiological data are incompatible with the prolactin value. physicians dealing with diagnosis and treatment of hyperprolactinemia (general practitioners, gynecologists, neurosurgeons, endocrinologists, and biochemists) should be aware of the potentially misleading nature of macroprolactin.- - - - - - - - - - ranking = 5keywords = pituitary (Clic here for more details about this article) |
18/123. "Hook effect" in prolactinomas: case report and review of literature.OBJECTIVE: To present a case of the "hook effect" occurring in the prolactin immunoassay in a patient with giant prolactinoma and to review this phenomenon. methods: We describe the clinical, biochemical, radiologic, and pathologic data of a patient with a giant prolactinoma, in which dilution testing of serum prolactin levels confirmed the presence of the hook effect. We discuss the historical and mechanistic aspects of the hook effect and then review its occurrence with the prolactin assay. RESULTS: A 65-year-old man sought medical attention because of headaches, personality changes, and "bulging" eyes. Cranial magnetic resonance imaging disclosed a 10-cm-diameter, lobulated, heterogeneous, locally invasive mass in the anterior skull base and cranial fossa. Initial laboratory testing showed a prolactin level of 164.5 ng/mL (normal range, 1.6 to 18.8). The pathology specimen from his surgical debulking procedure was consistent with prolactinoma. Retesting of the original serum prolactin sample with serial dilutions revealed a prolactin level of 26,000 ng/mL. A postoperative diluted prolactin level was 22,000 ng/mL. Both prolactin samples demonstrated the hook effect. dopamine agonist therapy was initiated, and the prolactin level and size of the tumor decreased substantially. The hook effect most commonly occurs when excess antigen (for example, prolactin) is present during testing. Dilution testing can counteract this assay phenomenon. CONCLUSION: Clinicians should be aware of this laboratory phenomenon when evaluating large pituitary or parasellar masses. When the hook effect is suspected, dilution testing of prolactin samples may prevent incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas.- - - - - - - - - - ranking = 1keywords = pituitary (Clic here for more details about this article) |
19/123. A case of autoimmune hypophysitis associated with Graves' disease.In a 76-year-old woman with hyperthyroidism, hyperprolactinemia and thickening of the pituitary stalk on magnetic resonance imaging (MRI) was presented. Thyroid stimulating antibody (TSAb) was positive and anti-pituitary antibodies against 49 and 68 kD human anterior pituitary membrane antigens were detected immunologically. Secretion of pituitary hormones was almost normal except for suppressed TSH and hyperprolactinemia. As autoimmune etiologies were likely involved in the disorders, autoimmune hypophysitis associated with Graves' disease was arrived at as the plausible diagnosis.- - - - - - - - - - ranking = 4keywords = pituitary (Clic here for more details about this article) |
20/123. Macroprolactin-a cause of pseudohyperprolactinaemia.Macroprolactin is a complex of immunoglobulin g and monomeric prolactin with little biological activity in vivo. Macroprolactin cross-reacts in modern commercial prolactin assays, however, leading to pseudohyperprolactinaemia. This report is of three patients with macroprolactinaemia and the untoward consequences if this benign condition is misdiagnosed as genuine hyperprolactinaemia are discussed. One adult and one child without symptoms of hyperprolactinaemia were incidentally found to have elevated serum prolactin levels, one of whom had a pituitary incidentaloma. Repeat prolactin measurement after polyethylene glycol precipitation showed that the majority of circulating prolactin was macroprolactin. The third patient had galactorrhoea and pituitary microadenoma. polyethylene glycol study showed that macroprolactinaemia exists simultaneously with genuine hyperprolactinaemia leading to falsely high serum prolactin levels. The recognition of this relatively common and benign condition is important in order to avoid misdiagnosis and unnecessary investigations and treatment. Particular attention must be paid to patients in whom the clinical and radiological findings are incompatible.- - - - - - - - - - ranking = 2keywords = pituitary (Clic here for more details about this article) |
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